MAY 2020 - Governments at all levels have enacted a wide range of temporary laws, regulations and services in the past few months in response to COVID-19. A number of these changes affect pharmacy and have put pharmacists very much at the forefront of ensuring continuity of care for patients.
To help put these changes in perspective, the Canadian Foundation of Pharmacy (CFP) contacted all of the provincial pharmacy associations and sorted through the formal documents of pharmacy regulators and ministries of health. We’re pulling together a chart that summarizes the new policies, programs and authorities for pharmacists—coming soon!—and we’re producing a series of articles that will take a closer look at individual provinces. This is our first installment, with a focus on Alberta.
New funded service
Alberta is the only province so far to implement a billable service tied directly to the current crisis, entitled the “Assessment to Screen and/or Test for Infectious Disease” service. The pharmacist provides information and care in relation to COVID-19 and/or conducts an assessment to determine if the patient is at risk for COVID-19. Pharmacies can bill $20 for the provision of information or assessment, for up to five patients per pharmacy per day.
Alberta Health implemented the service less than a week after it was proposed by the Alberta Pharmacists’ Association (RxA) in March. “We appreciate that this is a recognition of the work of pharmacists who are trying to help patients identify their risk,” said Matt Tachuk, RxA’s Director of Pharmacy Practice.
While the limit of five billings per day may fall short of assessments performed, it may be the best government can do at this time. “It does come down to what’s in the budget to be able to support this, recognizing that this could be a fairly widely applicable service, and that these are unprecedented times,” said Tachuk.
More importantly, the new billing code sets the stage for the service to possibly continue after emergency measures have been lifted. “Our approach was always to position this as a broadly applicable service related to screening and testing for infectious disease, during flu season for example,” explained Tachuk. “We are hopeful that government will see value in keeping the service in place.”
ADDENDUM: In late June, the Alberta government and RxA began a pilot project with 20 pharmacies, where pharmacists may screen and conduct point-of-care testing for COVID-19. The test involves a throat swab and only asymptomatic people can be tested. Pharmacies bill $20 for a screening only or $42 for a screening and test. Reimbursement is also available for transportation costs to the lab. On July 30, Alberta implemented the voluntary program across the province.
In March, Alberta was one of five provinces to recommend that pharmacies limit all prescription fills to 30-day supplies. Three provinces (Saskatchewan, Manitoba and New Brunswick) implemented mandatory 30-day maximums. In recent weeks, all mandatory and two recommended 30-day limits (in Prince Edward Island and Newfounland Labrador) have been discontinued. Pharmacists have been advised to return to filling maximum-day supplies and to use their judgement to determine if smaller quantities are warranted due to drug availability. For now, Alberta's recommended 30-day policy remains in place.
The 30-day supply recommendation definitely put a strain on both pharmacists and patients, confirmed Tachuk. While pharmacists could appreciate the rationale due to supply-chain issues, many patients could not—especially since it resulted in extra personal costs and more trips to the pharmacy. In response, Alberta Health modified its copays for seniors to help offset costs for the more frequent 30-day supply. And pharmacies in Alberta, like their counterparts across Canada, implemented curbside pickups and increased deliveries to maintain physical distancing.
Approximately half of pharmacists in Alberta have additional prescribing authority, which was a distinct advantage during the early weeks when many physician offices were closed or changing structure. “That did drive a lot of traffic to the pharmacy and prescribing services increased. If Alberta hadn’t had that ability for pharmacists to step in very quickly and help manage patients’ medications, the system would have been further challenged. Having a more enabled pharmacy workforce is definitely a benefit here in Alberta,” said Tachuk.
Pharmacists can also prescribe remotely over the phone, but other forms of virtual care (e.g., by videoconference) are not permitted.
Personal protective equipment
Like other pharmacy associations, RxA lobbied for government-sourced personal protective equipment (PPE). In April, pharmacists welcomed an initial shipment from the province’s Provincial Emergency Social Services program, valued at just under $200,000 and provided at no cost to pharmacies. Pharmacies choosing to re-order are now being invoiced for these costs.
Reliable access to affordable PPE could pose the biggest challenge going forward, especially as flu season approaches, noted Tachuk. “While some of the physical distancing approaches are reasonable to continue, when the public needs an in-person assessment they will be looking for access where they are protected. The public expects that their healthcare provider has PPE and wears a mask,” he said. “These are best practices, and pharmacists are doing everything they can to stay open, but you can’t wear what you don’t have.”